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General NPI Number Information
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NPI Number | 1205495173
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Entity Type | Individual
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Provider Name | TASHIA MOORE LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/13/2019
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Last Update Date | 10/19/2023
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Provider Practice Location Address
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Address Line | 1201 N WATSON RD STE 177
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City | ARLINGTON
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State | TX
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Zip | 76006-6223
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Country | US
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Telephone | 682-238-0151
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Fax |
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Provider Business Mailing Address
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Address Line | 539 W COMMERCE ST STE 298
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City | DALLAS
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State | TX
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Zip | 75208-1953
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Country | US
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Telephone | 254-251-1237
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 64999
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW61386001
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 64999
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 29354
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License Number State | MD
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 114138
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License Number State | CA
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